Bone fixation system, assembly, implants, devices, alignment guides, and methods of use

ABSTRACT

Implants, guides, devices, instruments, systems and methods for fixing a joint using bone plates are disclosed. The bone fixation system includes an alignment guide with a first end and a second end, an alignment wire rotatably coupled to the first end of the alignment guide, and a coupling member slidingly engaging a first portion of the alignment guide near the first end. The plate includes a body including a first end and a second end, a plurality of lobes extending from the body, a plurality of screw holes extending through the body and each screw hole of the plurality of screw holes positioned in a lobe of the plurality of lobes, and an alignment hole positioned along a longitudinal axis of the body. A method of using a bone fixation system for fixation of at least two bones is also disclosed.

CROSS REFERENCE TO RELATED APPLICATION

This application is a continuation of PCT Application No.PCT/US2018/025443 filed on Mar. 30, 2018, which claims priority benefitunder 35 U.S.C. § 119(e) of U.S. provisional application No. 62/478,984filed Mar. 30, 2017, which is incorporated herein by reference in itsentirety.

TECHNICAL FIELD

The present disclosure relates generally to general, podiatric, andorthopaedic surgery related to fixation of prepared joint surfaces. Morespecifically, but not exclusively, the present disclosure relates toimplants, guides, devices, instruments, systems and methods for fixing ajoint using bone plates.

BACKGROUND OF THE INVENTION

In patients with Charcot neuroarthropathy and other deformities of thefoot there may be a breakdown of the arch of the foot including themedial column resulting in pain, areas of increased pressure resultingin ulceration and instability. In order to alleviate the pain, increasedpressure and instability, it is sometimes necessary to performarthrodesis or fusion on the bones of the foot and ankle to place thefoot back into a plantigrade position. New and improved bone fixationsystems, assemblies, implants, alignment guides, and methods are neededto improve the stability of the patient's foot after arthrodesis orfusion.

SUMMARY OF THE INVENTION

The present disclosure is directed toward devices and methods for use infixation of a patient's joints or for fixation of a fracture. Thealignment guides provide an orientation for securement of a beamingscrew and bone plates across a patient's joint or fracture.

In one aspect of the present disclosure provided herein, is a bonefixation system. The bone fixation system includes an alignment guidewith a first end and a second end, an alignment wire rotatably coupledto the first end of the alignment guide, and a coupling member slidinglyengaging a first portion of the alignment guide near the first end.

In another aspect of the present disclosure provided herein, is a boneplate, that includes a body with a first end and a second end, aplurality of lobes extending from the body, a plurality of screw holesextending through the body with each screw hole of the plurality ofscrew holes being positioned in at least one lobe of the plurality oflobes, and an alignment hole positioned along a longitudinal axis of thebody.

In yet another aspect of the present disclosure provided herein, is amethod of using a bone fixation system for fixation of at least twobones. The method includes creating an incision near the at least twobones and preparing the at least two bones for fixation. The method alsoincludes inserting an alignment wire into one of the at least two bonesand coupling an alignment guide to the alignment wire. The methodfurther includes positioning a bone plate on the at least two bones andinserting a beaming screw into the at least two bones. Finally, themethod includes securing the bone plate to the at least two bones andclosing the incision.

These and other objects, features and advantages of this disclosure willbecome apparent from the following detailed description of the variousaspects of the disclosure taken in conjunction with the accompanyingdrawings.

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying drawings, which are incorporated in and constitute apart of the specification, illustrate embodiments of the disclosure andtogether with the detailed description herein, serve to explain theprinciples of the disclosure. It is emphasized that, in accordance withthe standard practice in the industry, various features are not drawn toscale. In fact, the dimensions of the various features may bearbitrarily increased or reduced for clarity of discussion. The drawingsare only for purposes of illustrating preferred embodiments and are notto be construed as limiting the disclosure.

FIG. 1 is a top perspective view of one embodiment of a bone fixationsystem, in accordance with an aspect of the present disclosure;

FIG. 2 is a first side perspective view of the bone fixation system ofFIG. 1, in accordance with an aspect of the present disclosure;

FIG. 3 is a second side perspective view of the bone fixation system ofFIG. 1, in accordance with an aspect of the present disclosure;

FIG. 4 is a first end perspective view of the bone fixation system ofFIG. 1, in accordance with an aspect of the present disclosure;

FIG. 5 is a top view of the bone fixation system of FIG. 1, inaccordance with an aspect of the present disclosure;

FIG. 6 is an exploded, top perspective view of the bone fixation systemof FIG. 1 and a bone plate and fasteners, in accordance with an aspectof the present disclosure;

FIG. 7 is an exploded, side view of the bone fixation system and boneplate of FIG. 6, in accordance with an aspect of the present disclosure;

FIG. 8 is an exploded, bottom perspective view of the bone fixationsystem, bone plate and fasteners of FIG. 6, in accordance with an aspectof the present disclosure;

FIG. 9 is an exploded, top perspective view of a portion of the bonefixation system of FIG. 1, in accordance with an aspect of the presentdisclosure;

FIG. 10 is an exploded, bottom perspective view of a portion of the bonefixation system of FIG. 1, in accordance with an aspect of the presentdisclosure;

FIG. 11 is a top perspective view of the bone plate of FIG. 6, inaccordance with an aspect of the present disclosure;

FIG. 12 is an end view of the bone plate of FIG. 6, in accordance withan aspect of the present disclosure;

FIG. 13 is a top view of the bone plate of FIG. 6, in accordance with anaspect of the present disclosure;

FIG. 14 is a back view of the bone plate of FIG. 6, in accordance withan aspect of the present disclosure;

FIG. 15 is a first side view of the bone plate of FIG. 6, in accordancewith an aspect of the present disclosure;

FIG. 16 is a second side view of the bone plate of FIG. 6, in accordancewith an aspect of the present disclosure;

FIG. 17 is a top view of another bone plate, in accordance with anaspect of the present disclosure;

FIG. 18 is a bottom perspective view of the bone plate of FIG. 17, inaccordance with an aspect of the present disclosure;

FIG. 19 is a dorsal perspective view of a portion of the bone fixationsystem of FIG. 1 positioned on a patient's foot, in accordance with anaspect of the present disclosure;

FIG. 20 is a dorsal perspective view of the guide wire and beaming screwof the bone fixation system of FIG. 1 positioned in a patient's foot, inaccordance with an aspect of the present disclosure;

FIG. 21 is a dorsal perspective view of a portion of the bone fixationsystem of FIG. 1 and the bone plate and fasteners of FIG. 6, inaccordance with an aspect of the present disclosure;

FIG. 22 is a dorsal perspective view of the bone fixation system of FIG.1 and the bone plate and fasteners of FIG. 6, in accordance with anaspect of the present disclosure;

FIG. 23 is a first perspective, side view of a portion of anothertargeting guide system with a protector member, in accordance with anaspect of the present disclosure;

FIG. 24 is a second perspective, side view of the portion of thetargeting guide system of FIG. 23, in accordance with an aspect of thepresent disclosure;

FIG. 25 is a first perspective, side view of the targeting guide systemof FIG. 23 with a drill guide after removal of the protector member, inaccordance with an aspect of the present disclosure;

FIG. 26 is a second perspective, side view of the targeting guide systemof FIG. 25, in accordance with an aspect of the present disclosure;

FIG. 27 is a perspective view of the targeting guide system of FIG. 25with a bone plate attached, in accordance with an aspect of the presentdisclosure;

FIG. 28 is another perspective view of the targeting guide system ofFIG. 27, in accordance with an aspect of the present disclosure;

FIG. 29 is an exploded perspective view of the complete targeting guidesystem of FIG. 23, in accordance with an aspect of the presentdisclosure;

FIG. 30 is another exploded, perspective view of the targeting guidesystem of FIG. 29, in accordance with an aspect of the presentdisclosure;

FIG. 31 is an exploded, first side view of the targeting guide system ofFIG. 29, in accordance with an aspect of the present disclosure;

FIG. 32 is an exploded, second side view of the targeting guide systemof FIG. 29, in accordance with an aspect of the present disclosure;

FIG. 33 is a dorsal view of the targeting guide system of FIG. 23positioned on a foot, in accordance with an aspect of the presentdisclosure;

FIG. 34 is a perspective view of the foot and targeting guide system ofFIG. 33 after a bone plate is secured to the foot with fasteners, inaccordance with an aspect of the present disclosure;

FIG. 35 is a perspective view of the foot and targeting guide system ofFIG. 34 after removal of the protector member and insertion of the drillguide, in accordance with an aspect of the present disclosure;

FIG. 36 is a perspective view of the foot of FIG. 35 after removal ofthe targeting guide system and insertion of a threaded member, inaccordance with an aspect of the present disclosure;

FIG. 37 is a side view of the foot of FIG. 36 after removal of thetarget pin, in accordance with an aspect of the present disclosure;

FIG. 38 is a top perspective view of the bone plate of FIG. 27, inaccordance with an aspect of the present disclosure;

FIG. 39 is an end view of the bone plate of FIG. 27, in accordance withan aspect of the present disclosure;

FIG. 40 is a top view of the bone plate of FIG. 27, in accordance withan aspect of the present disclosure;

FIG. 41 is a bottom view of the bone plate of FIG. 27, in accordancewith an aspect of the present disclosure;

FIG. 42 is a first side view of the bone plate of FIG. 27, in accordancewith an aspect of the present disclosure; and

FIG. 43 is a second side view of the bone plate of FIG. 27, inaccordance with an aspect of the present disclosure.

DETAILED DESCRIPTION FOR CARRYING OUT THE INVENTION

Generally stated, disclosed herein are implants, guides, devices,instruments, and systems for fixing a joint using bone plates. Further,methods for using the implants, guides, devices, instruments and systemsare discussed.

In this detailed description and the following claims, the wordsproximal, distal, anterior or plantar, posterior or dorsal, medial,lateral, superior and inferior are defined by their standard usage forindicating a particular part or portion of a bone or implant accordingto the relative disposition of the natural bone or directional terms ofreference. For example, “proximal” means the portion of a device orimplant nearest the torso, while “distal” indicates the portion of thedevice or implant farthest from the torso. As for directional terms,“anterior” is a direction towards the front side of the body,“posterior” means a direction towards the back side of the body,“medial” means towards the midline of the body, “lateral” is a directiontowards the sides or away from the midline of the body, “superior” meansa direction above and “inferior” means a direction below another objector structure. Further, specifically in regards to the foot, the term“dorsal” refers to the top of the foot and the term “plantar” refers thebottom of the foot.

Similarly, positions or directions may be used herein with reference toanatomical structures or surfaces. For example, as the current implants,devices, instrumentation and methods are described herein with referenceto use with the bones of the foot, the bones of the foot, ankle andlower leg may be used to describe the surfaces, positions, directions ororientations of the implants, devices, instrumentation and methods.Further, the implants, devices, instrumentation and methods, and theaspects, components, features and the like thereof, disclosed herein aredescribed with respect to one side of the body for brevity purposes.However, as the human body is relatively symmetrical or mirrored about aline of symmetry (midline), it is hereby expressly contemplated that theimplants, devices, instrumentation and methods, and the aspects,components, features and the like thereof, described and/or illustratedherein may be changed, varied, modified, reconfigured or otherwisealtered for use or association with another side of the body for a sameor similar purpose without departing from the spirit and scope of thedisclosure. For example, the implants, devices, instrumentation andmethods, and the aspects, components, features and the like thereof,described herein with respect to the right foot may be mirrored so thatthey likewise function with the left foot. Further, the implants,devices, instrumentation and methods, and the aspects, components,features and the like thereof, disclosed herein are described withrespect to the foot for brevity purposes, but it should be understoodthat the implants, devices, instrumentation and methods may be used withother bones of the body having similar structures.

Referring to the drawings, wherein like reference numerals are used toindicate like or analogous components throughout the several views, andwith particular reference to FIGS. 1-10, there is illustrated anexemplary embodiment of a bone fixation system 100 including a targetingguide assembly and a bone plate 200, 250. The bone fixation system 100includes an arm or alignment guide 110, a plate attachment member 130, aset screw or plate attachment member 140, a guide wire or sphere wire150, a guide wire or k-wire 170, a guide wire sleeve 180, and a screw190.

As shown in FIGS. 6-10, the alignment guide 110 includes a first end 112and a second end 114. The first end 112 includes a first portion or base116 and the second end 114 includes a second portion 118. The secondportion 118 may have a width, for example, greater than the firstportion 116 or the same width across its entire length. The alignmentguide 110 may taper from the second portion 118 to the first portion116. The first portion 116 may also include a pivoting head member 120at the first end 112. The pivoting member 120 may include a channel 122forming an opening in the pivoting head member 120. The channel oropening 122 may allow for the pivoting member 120 to deform or deflectfor insertion of the sphere wire 150. The channel or opening 122 mayalso provide a recess for the first end 152 of the sphere wire 150 whilethe pivoting member 120 is pivoting on the pivot protrusion 158 of thesphere wire 150. The channel 122 may include two retaining members orrecesses 124 on an interior surface of the pivoting member 120.Alternatively, the channel 122 may include a plurality of deformableretaining members (not shown) separated by a plurality of recesses thatsurround the channel 122 and are sized and shaped to receive the pivotprotrusion 152. The second portion 118 may include an opening or throughhole 126 extending through the second end 114 of the alignment guide110. The alignment guide 110 may also include length or measurementindicator lines 128 positioned along the region between the first andsecond portions 116, 118 and along the second portion 118.

The plate attachment or coupling member 130 may include a channel 132extending through the coupling member 130, as shown in FIGS. 6-10. Thechannel 132 may be, for example, sized and shaped to slide over thefirst portion 116 of the alignment guide 110. The coupling member 130may also include a leg or extension member 134 extending out at a bottomof the coupling member 130. In addition, the coupling member 130 mayinclude an opening 136 extending through the coupling member 130 along alongitudinal axis. The extension member 134 may include an alignmentprotrusion 138 extending from a bottom of the extension member 134, asshown in FIGS. 2, 5, 8 and 10. The alignment protrusion 138 may be sizedand shaped to engage a bone plate, for example, bone plate 200.

With continued reference to FIGS. 6-10, the set screw or plateattachment member 140 includes a body 142 with a first end and a secondend. The set screw 140 may also include a head portion 144 at the firstend and a threaded portion 146 at the second end. The head portion 144may have a diameter larger than a diameter of the body 142. The diameterof the head portion 144 may also be larger than the diameter of theopening 136 in the coupling member 130. The threaded portion 146 of theset screw 140 may include a thread that corresponds to the threading inan opening or screw hole of the bone plate 200.

The sphere wire 150 may include a first end 152 and a second end 154, asshown in FIGS. 1-10. The terms “sphere wire,” “pivoting member,” “gripwire,” and “alignment wire” may be used interchangeably herein as theeach essentially refer to a wire including a protrusion. The sphere wire150 may also include a wire portion 156 extending from the first end 152to a pivot protrusion or spherical member 158. The pivot protrusion 158may be, for example, spherical or may have a circular or roundcross-section and be sized and shaped to match the retaining member orrecesses 124 in the pivoting head member 120 at the first end 112 of thealignment arm 110. The pivot protrusion 158 may rotate within theretaining member 124 in the pivoting head 120. The pivoting member 150may also include a threaded insertion end 160 and a tapered region 162extending between the pivot protrusion 158 and the insertion end 154.The insertion end 154 may have a pointed tip for insertion into thepatient's foot.

The alignment guide system 100 may also include a guide wire or k-wire170, as shown in FIGS. 1-8. The guide wire 170 may include a first end172 and a second end or insertion end 174, as shown in FIGS. 6-8.

As shown in FIGS. 6-10, the guide wire sleeve 180 of the alignment guidesystem 100 may include a body 182 with a first end 184 and a second end186. The first end 184 may include a head portion or handle member. Thesecond end 186 may have a tapered end terminating with a bone contactingsurface that may be, for example, serrated or smooth. The guide wiresleeve 180 may also include a through hole or cannulation 188 extendingthrough the body 182 from the first end 184 to the second end 186. Thecannulation 188 may be, for example, sized and shaped to receive theguide wire 170.

The screw, beaming screw, solid screw or compression screw 190 mayinclude a first end 192 and a second end 194, as shown in FIGS. 6-8. Thehead portion of the screw 190 positioned at the first end 192 may be,for example, tapered from the first end 192 to the threaded shaftportion 196. The beaming screw 190 may include threads 196 along atleast a portion of the length. In addition, the beaming screw 190 mayinclude a through hole or cannulation 198 extending from the first end192 to the second end 194. The cannulation 198 may be sized and shapedto receive the guide wire 170 to allow for the beaming screw 190 tooptionally be inserted over the guide wire 170. A drill (not shown) mayoptionally be inserted over the guide wire 170 to create a path for thescrew 190 prior to inserting the screw 190 over the guide wire 170.Alternatively, the beaming screw 190 may be solid.

The bone fixation system 100 may also include a bone plate 200, as shownin FIGS. 6-8 and 11-16. The bone plate 200 may include a body 202 with afirst end 204 and a second end 206. The body 202 may also include aplurality of lobes 208 extending away from the body 202, as shown inFIGS. 11 and 13-16. The body 202 may also include a plurality of screwholes or openings 210. Each of the plurality of screw holes 210 may bepositioned in one of the plurality of lobes 208. The screw holes 210 arepositioned to allow for bone fastener trajectories that form alongitudinal opening or space between the bone fasteners 230 insertedthrough the screw holes 210. The longitudinal opening or space isgenerally parallel to the body 202 of the bone plate 200. The bonefastener trajectories of the screw holes 210 are selected to provide thelongitudinal opening for receiving a beaming screw 190 or to avoidinterference or intersection with an already inserted beaming screw 190.The longitudinal opening may extend through, for example, at least oneof the patient's joints. At least one of the plurality of screw holes210 may be sized and shaped to receive the threaded portion 146 of theplate attachment member or set screw 140 to secure the plate 200 to thecoupling member 130 of the alignment guide 110, as shown in FIGS. 21 and22.

As shown in FIGS. 11, 13 and 14, the bone plate 200 may also include afirst opening 214, a second opening 216, and a third opening 218positioned along the longitudinal axis of the plate 200. The openings214, 216, 218 may be, for example, sized and shaped to allow forvisualization of the bones. The body 202 may also include an alignmenthole 220 for receiving the alignment protrusion 138 of the couplingmember 130. The alignment hole 220 may be positioned generally centeredon the body 202. As shown, the alignment hole 220 may also be positionedbetween the first opening 214 and second opening 216 near a midpoint ofthe plate 200. Although not shown, the alignment hole 220 mayalternatively be positioned anywhere along the plate to provide forcoupling to the plate 200 with adequate visualization for the procedure.For example, the alignment hole 220 may be positioned between theopening 214 and the first end 204, between the openings 216, 218, orbetween the opening 218 and the second end 206. The third opening 218may be positioned between the second opening 216 and the second end 206,as shown in FIGS. 11, 13 and 14. As shown in FIG. 12, the body 202 maybe curved to match the curvature of the bones. The bone plate 200 mayalso include slots, as shown and described in greater detail below withreference to bone plate 500, positioned in the body 202 to allow fortemporary fixation and compression of the bones being coupled to theplate 200.

Referring now to FIGS. 17 and 18, another embodiment of a bone plate 250is shown. The bone plate 250 may include a body 252 with a first end 254and a second end 256. The body 252 may also include a plurality of lobes258 extending away from the body 252, as shown in FIGS. 17-18. The body252 may also include a plurality of screw holes or openings 260. Each ofthe plurality of screw holes 260 may be positioned in one of theplurality of lobes 258. At least one of the plurality of screw holes 260may be sized and shaped to receive the threaded portion 146 of the plateattachment member or set screw 140 to secure the plate 250 to thecoupling member 130 of the alignment guide 110.

With continued reference to FIGS. 17 and 18, the plate 250 also includesat least one alignment opening 262, 264 for receiving the alignmentprotrusion 138 of the coupling member 130. In the depicted embodiment,the plate 250 includes a first alignment opening 262 and a secondalignment opening 264. The alignment opening 262, 264 may be positioned,for example, anywhere along the length of the plate 250. In addition,the plate 250 includes a first opening 266 and a second opening 268 forvisualization of the bones during insertion.

The surgical method for using the bone fusion system 100 on a patient'sfoot 300 is shown in FIGS. 19-22. The method may use the bone fixationsystem 100 during an arthrodesis procedure, for example, for fusion ofat least the first metatarsal 302 and the medial cuneiform 304 at thefirst tarsometatarsal joint 312. The bone fixation system 100 may alsobe used for fusion of, for example, the first tarsometatarsal joint 312and naviculaocuneiform joint 314 to fuse the first metatarsal 302, themedial cuneiform 304 and the navicular 306 bones. It is alsocontemplated that the bone fixation system 100 may be used for fusionof, for example, the first metatarsal 302, the medial cuneiform 304, thenavicular 306, and the talus 308 bones at the first tarsometatarsaljoint 312, the naviculocuneiform joint 314 and the talonavicular joint316, respectively. The bone fixation system 100 may also be used fortreatment of Charcot neuroarthropathy where the breakdown of the medialcolumn of the foot has occurred and restoration of the medial foot isnecessary.

For example, the method may include making a skin incision to expose thefirst tarsometatarsal joint 312, the naviculocuneiform joint 314, thetalonavicular joint 316, and the first metatarsophalangeal joint 310.Next, preparation of the joints 312, 314, 316 is performed by, forexample, removing cartilage or performing osteotomies of the medialcolumn joints 312, 314, 316. The joints may be prepared, for example, toobtain a plantigrade foot. After the joints are prepared, a guide wire150, for example, a sphere wire may be placed into the talus 308. Inprocedures where fusion of the talonavicular joint 316 is not necessary,the sphere wire 150 may be placed in a more distal bone. The sphere wire150 may be placed to position the tip 154 of the wire 150 or thethreaded portion 160 of the wire 150 along the axis of the trajectorywhere a screw or beaming screw 190 will be inserted.

Next, an alignment guide 110 may be selected and coupled to the spherewire 150. The pivot protrusion 158 of the sphere wire 150 may be, forexample, inserted through the channel 122 and into engagement with theretaining member 124 inside of the pivoting head 120 of the alignmentguide 110 to couple the sphere wire 150 to the alignment guide 110. Thealignment guide 110 may be positioned to align the sleeve opening 126with the central aspect of the first metatarsophalangeal joint 310.Then, a guide wire sleeve 180 may be inserted through the opening 126 inthe distal end of the alignment guide 110. After the guide wire sleeve180 is positioned, a guide wire 170 may be driven through the centralaspect of the head of the first metatarsal 302, as shown in FIG. 19. Theguide wire 170 may be driven proximally through the first metatarsal 302and across, for example, the first tarsometatarsal joint 312, thenaviculocuneiform joint 314 and the talonavicular joint 316. Once theguide wire 170 is inserted through the joints 312, 314, 316, theposition of the guide wire 170 may be confirmed using fluoroscopy. Ifthe guide wire 170 is in the desired position, the alignment guide 110and the sphere wire 150 may be removed, for example, if only a beamingscrew 190 is being inserted into the patient's foot 300.

The beaming screw 190 may be inserted, as shown in FIG. 20, by drillingover the guide wire 170. After the drilling is complete, a cannulatedscrew, solid screw, or beaming screw 190 may be inserted into the firstmetatarsal 302 and across, for example, the first tarsometatarsal joint312, the naviculocuneiform joint 314 and the talonavicular joint 316, iffusion of all three joints is desired. The screw 190 may be, forexample, inserted over the guide wire 170 if the screw 190 iscannulated. Alternatively, if the screw 190 is solid, the guide wire 170may be removed and then the screw 190 may be inserted through theopening in the patient's bones 302, 304, 306, 308. The screw 190 may be,for example, a headed or headless screw and a partially or fullythreaded screw. The screw 190 may also have, for example, a tapered headportion with or without threads on the exterior surface.

In one embodiment, a bone plate 200 may be secured to the bones 302,304, 306, 308, as shown in FIG. 22, for additional fixation, after thebeaming screw 190 is inserted. Alternatively, the bone plate 200 may besecured to the bones after the guide wire 170 is placed but prior tobeaming screw 190 placement. The plate 200 may be coupled to thecoupling member 130 of the alignment guide 110 by aligning the opening136 of the coupling member 130 with a screw hole 210 of the plate 200.The alignment protrusion 138 may be inserted into the alignment hole 220in the plate 200 to assist with aligning the opening 136 with a screwhole 210. Next, a plate attachment member or set screw 140 may beinserted through the opening 136 and the threaded portion 146 may bescrewed into a screw hole 210 of the plate 200. The channel 132 of thecoupling member 130 may then be inserted over the first portion 116 ofthe alignment guide 110. Once the coupling member 130 is positioned onthe first portion 116 of the alignment guide 110, the coupled plate 200may be positioned on the patient's foot 300. The coupling member 130enables translation along the alignment guide 110 to move the plate in aproximal-distal direction until a desired positioning is achieved on thepatient's foot 300. The bone fixation system 100 also allows forrotation of the plate 200 in a frontal plane to allow for plate 200fixation on a slightly more dorsal or plantar position depending on thepatient's anatomy and desired correction. The coupled alignment guide110 and plate 200 may rotate about the pivot protrusion 158 of thesphere wire 150. The translation and rotation of the plate 200 withrespect to the patient's foot 300 allows for variations in the plate 200positioning and for on-axis placement of the plate 200. Once theposition of the plate is selected, bone plate screws 230 may be insertedthrough the screw holes 210 and the screw holes 210 may havetrajectories to avoid contacting or interference with the beaming screw190. In addition, the translation and rotation of the plate 200 allowsfor variations to the placement of the plate 200 before insertion of thebone plate screws 230 while still ensuring there is no contact orinterference with the beaming screw 190.

In another embodiment, as shown in FIG. 21, after placement of the guidewire 170, the plate 200 may be positioned on the patient's foot, asdescribed in greater detail above, which will not be described againhere for brevity sake. Next, the plate 200 may be secured to thepatient's bones 302, 304, 306, 308 by inserting bone fasteners 230through the plurality of openings or screw holes 210 in the plate 200.The plate 200 may be secured to the patient's foot 300 prior toinsertion of the beaming screw 190. The plurality of screw holes 210 mayinclude insertion trajectories forming an opening or space between theplurality of bone fasteners 230 for insertion of the beaming screw 190.Once the plate 200 is attached to the patient's foot 300, then the guidewire sleeve 180 may be removed and a drill may be inserted over theguide wire 170 to drill an opening for a beaming screw 190. Next, ascrew 190 may be inserted into the patient's foot 300. As the screw 190is inserted, the screw 190 will avoid interference and/or intersectionwith the bone fasteners 230 and trajectory thereof. Once the screw 190is positioned in the bones 302, 304, 306, 308, then the guide wire 170,spherical wire 150, and alignment guide 110 may be removed from thepatient.

Finally, once the beaming screw 190 and/or plate 200 are secured to thepatient's bones 302, 304, 306, 308, the arthrodesis procedure may becompleted and the incision may be closed.

Referring now to FIGS. 23-43, another bone fixation system is shown. Thebone fixation system may include a targeting guide assembly 400 and abone plate 500. The targeting guide assembly 400 includes a guide arm410, a target member 430, an implant holder 460, and a guide pin 490.The target member 430 is received within a first end of the guide arm410. The implant holder 460 moveably engages the guide arm 410 and may,for example, slide along a top surface of a body 412 of the guide arm410 to allow for location adjustability of a bone plate 500, as shown inFIGS. 34 and 35. The guide pin 490 rotatably couples to the second endof the guide arm 410. The implant holder 460 couples to a bone plate500.

As shown in FIGS. 23-32, the guide arm 410 includes a body 412connecting a first end 414 and a second end 416 of the guide arm 410.The first end 414 may, for example, include a wider portion 420 thatincludes arcuate sides that may attach the wider portion 420 in agenerally perpendicular direction relative to the body 412. The widerportion 420 may also include a through hole 422 that is sized and shapedto receive the target member 430. The through hole 422 may be, forexample, larger or smaller than as shown in FIGS. 23-32. The throughhole 422 may extend through the wider portion 420 parallel to the body412 allowing the target member 430 to extend parallel to the body 412 ofthe guide arm 410. The second end 416 may, for example, include anangled portion 418. The angled portion 418 extends in a downward angleddirection from the body 412 to the second end 416. A housing element 424may be positioned at the second end 416 and be configured or sized andshaped to receive the guide pin 490. The housing element 424 may includea top opening 426 and a bottom opening 428 forming an inner surface orcavity extending between the top opening 426 and the bottom opening 428.The housing element 424 may also include a channel extending from anexterior surface of the housing element 424 into the inner surface. Theinner surface may be, for example, configured or sized and shaped toallow the guide pin 490 to pivot, rotate, or move in multiple planes.The top opening 426 may be sized to allow for insertion of a sphere 494of the guide pin 490 into the housing element 424. The bottom opening428 may be, for example, slightly smaller than the top opening 426 tocapture or retain the guide pin 490 within the inner cavity of thehousing element 424.

The target member 430 is shown in FIGS. 29-32 and includes a target pin432, a protector member 434, a drill guide 440, and a threaded member orimplant 450. The target pin 432 may be, for example, a guide wire,k-wire, pin, or the like elongated pin like structure or member forinsertion through a joint. In the depicted embodiment the target pin 432has a smooth outer surface with a point or sharped portion at one end.

The target pin 432 may be, for example, inserted from a distal toproximal direction through the cannulated opening of the protectormember or guide wire targeting guide 434 when inserted into a bonepathway to secure the targeting guide in the surgical site and allow forthe establishment of a target location proximally. The protector member434 may include a knob 436 at a first end of a cylindrical portion 438.The protector member 434 may also include a through hole or cannulatedopening extending through the protector member 434 along a longitudinalaxis of the protector member 434. The protector member 434 may, forexample, protect the surrounding soft tissue when the target pin 432 isinserted through the protector member 434 and into a patient's bones.The drill guide 440 may include a cylindrical portion 442 and a knob 444positioned at a first end of the cylindrical portion 442. Thecylindrical portion 442 of the drill guide 440 may have, for example, alarger diameter than the cylindrical portion 438 of the protector member434. The drill guide 440 may also include a through hole or cannulatedopening 446 extending along a longitudinal axis of the drill guide 440.The cannulated opening 446 of the drill guide 440 may be, for example,sized to receive the protector member 434. The drill guide 440 may, forexample, protect the surrounding soft tissue when a drill is insertedthrough the cannulated opening 446 to drill an opening for inserting thethreaded member 450. In one embodiment, the drill guide 440 may beinserted into the through hole 422 of the guide arm 410, the protectormember 434 may be inserted into the cannulated opening 446, and thetarget pin 432 may be inserted through the protector member 434. In analternative embodiment, the protector member 434 may be inserted intothe through hole 422 of the guide arm 410, the target pin 432 may beinserted through the protector member 434, and then, the protectormember 434 may be removed and the drill guide 440 inserted into thethrough hole 422 of the guide arm 410 over the target pin 432. Thethreaded member or implant 450 may include a head portion 452 at a firstend of the threaded member 450 and cutting flutes 454 at a second end ofthe threaded member 450. The cutting flutes 454 may facilitate theinsertion of the threaded member 450 into bones. In addition, thethreaded member 450 may include a through hole or cannulated opening 456extending through the threaded member 450 along a longitudinal axis. Thethrough hole 456 may be configured or sized and shaped to receive thetarget pin 432. Alternatively, the threaded member 450 may be, forexample, solid without a longitudinal opening. As shown, the threadedmember 450 is threaded along the entire length, however, it is alsocontemplated that the threaded member 450 may be threaded along only aportion, for example, having partially or segmentally divided threadsalong the length.

The implant holder 460 may include a housing 462, a knob 474 and alocking member 480. The housing 462 may include an attachment arm 464extending from and parallel to the housing 462 to form, for example, aU-shaped or hook like structure. The attachment arm 464 hooks under thebottom of the body 412 of the guide arm 410 to permit the slidingmovement along the longitudinal axis of the body 412. A channel 466 isformed between the attachment arm 464 and the housing 462. Theattachment arm 464 may also include at least one hole 468 extendingthrough the attachment arm 464 from an exterior surface into the channel466. The at least one hole 468 may be, for example, three holes. Theimplant holder 460 may also include an alignment post 470 extending awayfrom a bottom surface of housing 462. The implant holder 460 may furtherinclude a through hole 472 extending through the housing 462 from a topsurface to a bottom surface adjacent to the alignment post 470. The knob474 may include an engagement protrusion 476 extending away from a backsurface of the knob 474. The engagement protrusion 476 may be, forexample, threaded to engage the at least one hole 468 to secure theimplant holder 460 to the body 412 of the guide arm 410 at the desiredposition. The locking member 480 may include a shaft 482 with a knob 484at a first end and a threaded portion 486 at a second end. The shaft 482may be inserted through the through hole 472 of the housing 462 untilthe knob 484 contacts a top surface of the housing 462 and the threadedportion 486 extends past the bottom surface of the housing 462. Thethreaded portion 486 may engage a bone plate, such as bone plate 500, asdescribed in greater detail below. The knob 474 may be rotated to insertthe threaded portion 486 into the bone plate 500 and to remove thethreaded portion 486 from the bone plate 500.

As shown in FIGS. 23-32, the guide pin 490 includes a shaft 492, asphere 494, a tip 496, and a cylindrical protrusion 498. The sphere orspherical member 494 may be positioned between a first end and the tip496. The tip 496 is threaded, however, it is also contemplated that thetip 496 may also have a smooth outer surface to facilitate insertion.The tip 496 is configured or sized and shaped to allow for the user toinsert the guide pin 490 into a target bone either directly or throughthe skin. Once inserted into the target bone, the guide pin 490 may besecured to establish the target location for the threaded member 450.The sphere 494 is sized and shaped or configured to be inserted into thehousing element 424 to allow for a full range of pivoting motions, asshown in FIGS. 23-28 and 33-35. The cylindrical protrusion 498 may bepositioned adjacent to the sphere 494 between the sphere 494 and the tip496.

The targeting guide assembly 400 may be assembled by inserting the guidepin 490 into the housing element 424 of the guide arm 410. The protectormember 434 may be inserted into the through hole 422 of the guide arm410 to receive the target pin 432. In addition, the implant holder 460may be aligned with the body 412 of the guide arm 410 and be secured inthe desired position by engaging the engagement protrusion 476 with thebody 412. The locking member 480 may be inserted into the opening 472 ofthe housing 462. Then, the alignment post 470 may be aligned with acorresponding alignment opening 518 in the bone plate 500, as shown inFIGS. 38, 40 and 41, and the threaded portion 486 of the locking member480 may engage a corresponding screw hole 510 positioned adjacent to thealignment opening 518 in the bone plate 500. In addition, the protectormember 434 may be removed and the drill guide 440 may be inserted intothe through hole 422 of the guide arm 410 over the target pin 432.

As shown in FIGS. 38-43, the bone plate 500 may further include a body502 with a first end 504 and a second end 506. The plate 500 may alsoinclude a plurality of lobes 508 positioned along the length of theplate 500. Each of the lobes 508 may include, for example, a screw holeor opening 510 for receiving a bone fastener, such as bone fasteners540, as shown in FIGS. 34-37. The plate 500 may also include a groove512 extending, for example, perpendicular to the longitudinal axis ofthe plate 500, as shown in FIGS. 38, 40, 42, and 43. The groove 512 maybe positioned, for example, between two lobes 508 and two screw holes510 on each side of the plate 500. The plate 500 may further include afirst opening 514 and a second opening 516 positioned along thelongitudinal axis of the plate 500. The openings 514, 516 may be, forexample, sized and shaped to allow for visualization of the bones. Thebody 5020 may also include an alignment hole 518 for receiving thealignment post 470 of the implant holder 260. The alignment hole 518 maybe, for example, positioned generally centered on the body 502 andbetween the first end 504 and the first opening 514. It is alsocontemplated that the alignment hole 518 may be, for example, positionedat alternative locations along the longitudinal axis of the plate 500that allow for adequate visualization to perform the surgical procedure.In addition, the plate 500 may include a first pair of channels or slots520 and a second pair of channels or slots 526. The first pair ofchannels 520 may include a first channel or slot 522 and a secondchannel or slot 524 positioned spaced apart from and adjacent to thefirst channel 522. The first pair of channels 520 may be, for example,positioned between the first opening 514 and the second opening 516. Thesecond pair of channels 526 may include a third channel or slot 528 anda fourth channel or slot 530 positioned spaced apart from and adjacentto the third channel 528. The second pair of channels 526 may be, forexample, positioned between the second opening 516 and the second end506 of the plate 500. The channels or slots 522, 524, 528, 530 may, forexample, allow for temporary fixation and compression of the bones beingcoupled to the plate 500. As shown in FIG. 39, the body 502 may becurved to match the curvature of the bones.

Referring now to FIGS. 33-37, a method for using the targeting guideassembly 400 to correct bone deformities is shown. The method mayinclude, for example, performing an arthrodesis across at least onejoint. The at least two bones of the at least one joint may bepositioned in a desired final position and may be temporarily fixed. Asshown in FIG. 33, the method may also include inserting a guide pin 490into a first bone 550 to set the trajectory for the target pin 432 andthe threaded member 450. Next, the housing element 424 of the guide arm410 may be coupled to the sphere 494 of the guide pin 490. The guide arm410 may be rotated about the sphere 494 to position the first end 414 ofthe guide arm 410 with respect to a second bone 552. Next, the protectormember 434 may be inserted into the through hole 422 and a target pin432 may be inserted through the protector member 434 and into at leastone bone 552, 554, 556, 550. Alternatively, the drill guide 440 may beinserted into the through hole 422, the protector member 434 may beinserted into the cannulated opening 446 of the drill guide 400, andthen the target pin 432 may be inserted through the protector member 434and into at least one bone 552, 554, 556, 550. The trajectory of thetarget pin 432 will overlap or engage the guide pin 490. In oneembodiment, the implant holder 460 may be coupled to the guide arm 410before the guide arm 410 is coupled to the guide pin 490. Alternatively,the implant holder 460 may be coupled to the guide arm 410 after thetarget pin 432 is inserted into the bones 552, 554, 556, 550. The boneplate 500 may then be coupled to the implant holder 460 and aligned onthe bones 552, 554, 556, 550, as shown in FIG. 34. It is alsocontemplated that the bone plate 500 may be coupled to the implantholder 460 prior to the guide arm 410 being coupled to the guide pin490. Once the bone plate 500 is coupled to the implant holder 460, theposition of the implant 500 may be adjusted along the length of theguide arm 410 to allow for implant positioning in a first plane, forexample, the sagittal plane. The guide arm 410 may alternatively or inaddition to adjustment along the length be rotated around the guide pin490 to rotate the bone plate 500 in a second plane, for example, thefrontal plane. Movement of the bone plate 500 in the two planes allowsfor fixation devices or bone screws 540 to be inserted with a trajectoryto avoid contacting the target pin 432 and/or threaded member 450. Thebone plate 500 may be secured to the bones 552, 554, 556, 550 with bonefasteners 540 inserted to avoid contacting the target pin 432 and thethreaded member 450 when inserted. The bone fasteners or fixationdevices 540 may be, for example, locking or non-locking fasteners. Themethod may then include removing the protector member 434 by sliding theprotector member 434 out of the through hole 422 of the guide arm 410over the target pin 432. As shown in FIG. 35, the drill guide 440 maythen be inserted through the through hole 422 over the target pin 432and positioned onto a bone 552. A cannulated drill may be used to drillover the target pin 432. The cannulated drill and drill guide 440 maythen be removed from the guide arm 410 and the threaded member 450 maybe inserted over the target pin 432 and into the bones 552, 554, 556,550, as shown in FIG. 36. Although not shown, it is also contemplatedthat the bone plate 500 may be coupled to the bones 552, 554, 556, 550after the threaded member 450 is inserted into the bones 552, 554, 556,550. As also shown in FIG. 36, the guide arm 410 and guide pin 490 maybe removed from the bones 552, 554, 556, 550. Finally, as shown in FIG.37, the target pin 432 may be removed from the bones 552, 554, 556, 550and the threaded member 450.

As may be recognized by those of ordinary skill in the art based on theteachings herein, numerous changes and modifications may be made to theabove-described and other embodiments of the present disclosure withoutdeparting from the scope of the disclosure. The components of theinstruments, guides, implants, plates, and/or systems as disclosed inthe specification, including the accompanying abstract and drawings, maybe replaced by alternative component(s) or feature(s), such as thosedisclosed in another embodiment, which serve the same, equivalent orsimilar purpose as known by those skilled in the art to achieve thesame, equivalent or similar results by such alternative component(s) orfeature(s) to provide a similar function for the intended purpose. Inaddition, the instruments, guides, implants, plates, and/or systems mayinclude more or fewer components or features than the embodiments asdescribed and illustrated herein. For example, the components andfeatures of FIGS. 1-10 and FIGS. 23-32 may be used interchangeably andin alternative combinations as would be modified or altered by one ofskill in the art. In addition, the components and features of FIGS.11-16, FIGS. 17-18, and FIGS. 38-43 may be used interchangeably and inalternative combinations as would be modified or altered by one of skillin the art. Further, the steps of the surgical methods associated withFIGS. 19-20, FIGS. 21-22, and FIGS. 33-37 may be used interchangeablyand in alternative combinations as would be modified or altered by oneof skill in the art. Accordingly, this detailed description of thecurrently-described embodiments is to be taken in an illustrative, asopposed to limiting of the disclosure.

The terminology used herein is for the purpose of describing particularembodiments only and is not intended to be limiting of the disclosure.As used herein, the singular forms “a”, “an” and “the” are intended toinclude the plural forms as well, unless the context clearly indicatesotherwise. It will be further understood that the terms “comprise” (andany form of comprise, such as “comprises” and “comprising”), “have” (andany form of have, such as “has”, and “having”), “include” (and any formof include, such as “includes” and “including”), and “contain” (and anyform of contain, such as “contains” and “containing”) are open-endedlinking verbs. As a result, a method or device that “comprises,” “has,”“includes,” or “contains” one or more steps or elements possesses thoseone or more steps or elements, but is not limited to possessing onlythose one or more steps or elements. Likewise, a step of a method or anelement of a device that “comprises,” “has,” “includes,” or “contains”one or more features possesses those one or more features, but is notlimited to possessing only those one or more features. Furthermore, adevice or structure that is configured in a certain way is configured inat least that way, but may also be configured in ways that are notlisted.

The invention has been described with reference to the preferredembodiments. It will be understood that the architectural andoperational embodiments described herein are exemplary of a plurality ofpossible arrangements to provide the same general features,characteristics, and general system operation. Modifications andalterations will occur to others upon a reading and understanding of thepreceding detailed description. It is intended that the disclosure beconstrued as including all such modifications and alterations.

What is claimed is:
 1. A bone fixation system, comprising: a targetingguide assembly; and a bone plate removably coupled to the targetingguide assembly.
 2. The bone fixation system of claim 1, wherein thetargeting guide assembly comprises: an alignment guide with a first endand a second end; an alignment wire rotatably coupled to the first endof the alignment guide; and a coupling member slidingly engaging a firstportion of the alignment guide near the first end.
 3. The bone fixationsystem of claim 2, further comprising: a guide wire sleeve removablyinserted through the second end of the alignment guide, and wherein theguide wire sleeve has a through hole and the through hole is positionedto align with at least a portion of an insertion end of the alignmentwire; a guide wire removably inserted through the guide wire sleeve,wherein the guide wire is positioned to align with at least a portion ofthe insertion end of the alignment wire; and a drill guide removablyinserted through the second end of the alignment guide, wherein thedrill guide comprises; a cannulated opening extending along alongitudinal axis of the drill guide; and wherein the guide wire sleeveis removably inserted through the cannulated opening of the drill guide.4. The bone fixation system of claim 2, wherein the coupling membercomprises: an extension member, wherein the extension member couples toa portion of the bone plate.
 5. The bone fixation system of claim 4,wherein the coupled bone plate and coupling member translate in aproximal-distal direction along the first portion of the alignmentguide; and wherein rotation of the alignment guide on the alignment wirerotates the coupled bone plate and coupling member.
 6. The bone fixationsystem of claim 4, wherein the bone plate comprises: a body including afirst end and a second end; a plurality of lobes extending from thebody; and a plurality of screw holes extending through the body, whereineach lobe of the plurality of lobes includes a screw hole of theplurality of screw holes, wherein each screw hole extends through eachlobe.
 7. The bone fixation system of claim 6, wherein the plurality ofscrew holes each have an insertion trajectory for each of a plurality ofbone fasteners and the insertion trajectories define a longitudinalopening extending between the plurality of bone fasteners generallyperpendicular to the body of the bone plate for receiving a screw. 8.The bone fixation system of claim 6, wherein the bone plate furthercomprises: at least one alignment hole extending through the bone plateperpendicular to a longitudinal axis of the bone plate, wherein the atleast one alignment hole receives an alignment protrusion extending awayfrom the extension member of the coupling member.
 9. The bone fixationsystem of claim 8, wherein the at least one alignment hole is selectedfrom the group consisting of one alignment hole and two alignment holes.10. The bone fixation system of claim 8, wherein the coupling memberfurther comprises: a plate attachment member inserted through an openingin the coupling member, wherein the plate attachment member includes athreaded portion and the threaded portion engages a screw hole of theplurality of screw holes positioned adjacent to the alignment hole. 11.The bone fixation system of claim 10, wherein the bone plate furthercomprises: a groove inset into a top surface of the bone plate, andwherein the groove extends across the bone plate perpendicular to thelongitudinal axis; at least one opening positioned along a longitudinalaxis of the bone plate and extending through the bone plate; and atleast one slot positioned along the longitudinal axis of the bone plate.12. The bone fixation system of claim 11, wherein the at least one slotcomprises: a first pair of slots extending through the bone plate; and asecond pair of slots extending through the bone plate and spaced apartfrom the first pair of slots.
 13. The bone fixation system of claim 12,wherein the first pair of slots comprises: a first slot; and a secondslot positioned spaced apart from and parallel to the first slot, andwherein the first slot is offset along the longitudinal axis from thesecond slot; and wherein the second pair of slots comprises: a thirdslot; and a fourth slot positioned spaced apart from and parallel to thethird slot, and wherein the third slot is offset along the longitudinalaxis from the fourth slot; and wherein the first pair of slots ispositioned between a first opening of the at least one opening and asecond opening of the at least one opening and the second pair of slotsis positioned between the second opening and a second end of the boneplate.
 14. A bone plate, comprising: a body including a first end and asecond end; a plurality of lobes extending from the body; a plurality ofscrew holes extending through the body, wherein each lobe of theplurality of lobes includes a screw hole of the plurality of screwholes, wherein each screw hole extends through each lobe; and at leastone alignment hole positioned along the body.
 15. The bone plate ofclaim 14, further comprising: a groove inset into a top surface of thebone plate, the groove extending across the bone plate perpendicular toa longitudinal axis of the bone plate; and at least one openingpositioned along the longitudinal axis of the bone plate and extendingthrough the bone plate.
 16. The bone plate of claim 15, furthercomprising: at least one slot positioned along the longitudinal axis ofthe bone plate.
 17. The bone plate of claim 16, wherein the at least oneslot comprises: a first pair of slots extending through the bone plate,wherein the first pair of slots comprises: a first slot; and a secondslot positioned spaced apart from and parallel to the first slot, andwherein the first slot is offset along the longitudinal axis from thesecond slot; and a second pair of slots extending through the bone plateand spaced apart from the first pair of slots, wherein the second pairof slots comprises: a third slot; and a fourth slot positioned spacedapart from and parallel to the third slot, and wherein the third slot isoffset along the longitudinal axis from the fourth slot.
 18. The boneplate of claim 17, wherein the first pair of slots is positioned betweena first opening of the at least one opening and a second opening of theat least one opening and the second pair of slots is positioned betweenthe second opening and a second end of the bone plate.
 19. The boneplate of claim 14, wherein the plurality of screw holes are positionedto form an opening between the plurality of screw holes for a screw. 20.A method of using a bone fixation system for fixation of at least twobones, comprising: creating an incision near the at least two bones;preparing the at least two bones for fixation; inserting an alignmentwire into one of the at least two bones; coupling an alignment guide tothe alignment wire; positioning a bone plate on the at least two bones;inserting a screw into the at least two bones; securing the bone plateto the at least two bones; and closing the incision.